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目的 比较不同急性肾损伤(AKI)标准(RIFLE、AKIN、KDIGO和传统标准)在评估慢加急性肝衰竭患者并发急性肾损伤的发生率和病死率中的应用. 方法 选取358例慢加急性肝衰竭患者,分别应用RIFLE、AKIN、KDIGO及传统急性肾损伤诊断标准评估患者AKI的发生率、疾病分级及预后情况.应用受试者工作特征(ROC)曲线比较四种标准预测患者30 d病死率的能力.计数资料的比较选用x2检验和Fisher's精确检验,logistic回归分析评估四种诊断标准与病死率的相关性,采用ROC曲线下面积(AUC)评估四种诊断标准预测病死率的准确性. 结果 KDIGO标准诊断AKI的发生率准确性最高(45.0％),其次为AKIN(38.8％)、RIFLE(35.5％)、传统标准(20.4％).AKIN和KDIGO标准在诊断慢加急性肝衰竭患者AKI的发生中更为敏感(72％),能识别更多的AKI患者,尤其对发现早期肾损伤更有意义.传统标准预测患者病死率更为特异(92％).传统标准评估短期病死率的受试者工作特征曲线下面积最大(0.75),其次为AKIN(0.72)、RIFLE (0.70)和KDIGO (0.69,P＜ 0.05).随着AKI严重程度加重,患者病死率逐步增加. 结论 AKI传统诊断标准预测慢加急性肝衰竭患者病死率比其他标准(RIFLE、AKIN、KDIGO)更特异,而AKIN和KDIGO标准对诊断AKI的发生更敏感,能识别早期肾损伤.

Objective To compare the acute kidney injury classification systems of RIFLE,AKIN,KDIGO and conventional criteria for determining prognosis of acute-on-chronic liver failure (ACLF) patients.Methods Patients with ACLF admitted to our hospital between July 2008 and March 2014 were enrolled in the study.The incidence,stages,and outcomes of acute kidney injury were determined according to the RIFLE,AKIN,KDIGO and conventional criteria.ROC curves were generated to compare the predictive ability for 30-day mortality of the four systems.Chi-square test and Fisher's exact test were used for statistical analyses,as well.Results All four classification systems detected acute kidney injury among the patients in the study population (n =358),but the detection rates were not consistent (expressed as ％ of total):KDIGO criteria:45.0％,AKIN:38.8％,RIFLE:35.5％,conventional criterion:20.4％.The KDIGO and AKIN criteria showed higher sensitivity (72％),especially to early kidney injury,but the conventional criterion showed higher specificity (92％).The AUC for 30-day mortality was highest for the conventional criteria (0.75),followed by AKIN (0.72),RIFLE (0.70) and KDIGO (0.69) (all,P ＜ 0.05).In-hospital mortality increased with severity of AKI in a stepwise manner.Conclusion Among the four common evaluation systems for acute kidney injury,the conventional criteria has the highest specificity for predicting short-term prognosis of patients with ACLF,while the AKIN and KDIGO criteria have the highest sensitivity for the presence of acute kidney injury,especially at the early stage.